Datasets:
| {"review_pmid":"39952828","title":"A systematic review and meta-analysis on physical activity for the treatment of anxiety in older adults","abstract":"Objectives: Symptoms of anxiety and anxiety disorders negatively impact the quality of life of older adults. Physical activity is a potentially accessible intervention with other health benefits and minimal risk, yet its impact on anxiety in older adults is unclear. Design: Systematic review and meta-analysis. Setting: Included databases were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO and CINHAL were searched from inception to June 23, 2023. Participants, interventions, measurements: We included randomized controlled trials of older adults who reported anxiety symptoms or disorders at baseline, that compared physical activity interventions with a non-physical activity comparator. All steps were done in duplicate, and certainty of evidence was with Grading of Recommendations, Assessment, Development, and Evaluations. Random effects meta-analyses were performed. Results: 10,763 citations were reviewed, 13 studies were included in meta-analyses. At baseline, participants self-reported low to moderate levels of anxiety and different levels of fitness. In the meta-analysis, the physical activity intervention had a medium effect in decreasing the severity of anxiety symptoms compared to the control (standardized mean differences (SMD) -0.66; 95% Confidence Interval (CI) -0.89, -0.43). Subgroup analyses indicated reductions in symptom severity when only assessing the effects of in-person interventions (SMD: -0.59; 95% CI: -0.79, -0.38), studies of participants without pre-existing diseases (SMD: -0.74; 95% CI: -0.99, -0.50), resistance training (SMD: -0.76; 95% CI: -1.15, -0.38) and aerobic exercise (SMD: -0.82; 95% CI: -1.15, -0.49). Studies had small sample sizes and high risk of bias. Conclusions: Physical activity reduces symptoms of anxiety in older adults and is an acceptable and promising intervention to incorporate into care planning.","population":"Older adults aged ≥60 years, or with a mean sample age ≥65 years, who present with self-reported symptoms of anxiety or a formally diagnosed anxiety disorder (e.g., generalized anxiety disorder [GAD], panic disorder, or other DSM-5 anxiety subtypes) at baseline, measured by any validated anxiety assessment tool (e.g., Spielberger State-Trait Anxiety Inventory [STAI], Hamilton Anxiety Rating Scale [HAM-A]). Studies focused exclusively on fear of falling are excluded.","intervention_or_exposure":"Structured moderate-to-vigorous intensity physical activity or exercise interventions, encompassing resistance/strength training, aerobic exercise (e.g., walking, cycling, dance, floorball), and mixed/multicomponent programs, delivered either in-person or as home-based programs, for any duration and frequency. Interventions consisting only of light-intensity activities (e.g., yoga, Tai Chi) that do not meet moderate-to-vigorous criteria are excluded.","comparator":"Non-physical activity comparators, including no intervention, usual care, waitlist control, or any active control that does not involve physical activity or structured exercise.","outcome":"Primary outcome: severity of anxiety symptoms measured by validated self-reported scales (e.g., STAI trait subscale preferred over state subscale for its stability; HAM-A). Secondary outcomes include physical function, social function, and health-related quality of life (not quantitatively synthesized due to insufficient reporting across included studies)."} | |
| {"review_pmid":"40325863","title":"The Efficacy of Non-Pharmacological Interventions for Sleep Disorders in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis","abstract":"Sleep disorders significantly impact the quality of life in people with multiple sclerosis (pwMS), affecting up to 60% of this population. These disorders, including insomnia, sleep apnea, restless legs syndrome, narcolepsy, and REM sleep behaviour disorders, result from both the direct neurological impacts of MS and secondary factors, such as pain and medication side effects. Non-pharmacological interventions offer potential benefits without the adverse effects associated with medications. This systematic review and meta-analysis aimed to evaluate the efficacy of non-pharmacological interventions in improving sleep disorders in pwMS, address inconsistencies in individual studies, and provide estimates of the magnitude of improvement. The review followed PRISMA guidelines and included randomised controlled trials, even if pilot studies, that examined non-pharmacological interventions for sleep disorders in pwMS. The literature search was completed in April 2024 in PubMed, Embase, and Web of Science databases. Data were extracted on study design, participant characteristics, intervention details, and outcomes. Quality was assessed using the PEDro scale, and a random-effects meta-analysis was conducted. The primary outcome was the assessment of sleep quality. Nine studies met the inclusion criteria, encompassing various non-pharmacological interventions such as cognitive-behavioural therapy, mindfulness, aerobic exercise, and occupational therapy. Non-pharmacological interventions may effectively improve sleep disorders in pwMS, while also providing additional benefits for overall psychological well-being and quality of life. Future research should focus on long-term effects, underlying mechanisms, and standardising intervention protocols to enhance comparability and generalisability. The major limitation of the meta-analysis is the high heterogeneity among eligible studies.","population":"People with multiple sclerosis (pwMS) aged ≥18 years, with MS clinically diagnosed based on McDonald's 2017 criteria, who have a co-occurring sleep disorder (including insomnia, sleep apnea, restless legs syndrome [RLS], narcolepsy, or REM sleep behaviour disorder) confirmed by validated cut-off values on self-reported questionnaires. All MS subtypes and disability levels are eligible.","intervention_or_exposure":"Any non-pharmacological intervention aimed at improving sleep outcomes in pwMS, including but not limited to: cognitive-behavioural therapy for insomnia (CBT-I), mindfulness-based stress reduction (MBSR), aerobic exercise, exergaming, occupational therapy (e.g., PEOP model-based), and multi-component programs combining behavioural, physical, and educational strategies. Interventions may be delivered individually or in groups, in clinical or home settings, at any intensity, frequency, or duration.","comparator":"Standard care (care-as-usual), attentional/active control (e.g., sedentary activities, light stretching), or waitlist control, without an active non-pharmacological sleep-specific intervention.","outcome":"Primary outcome: sleep quality measured by validated patient-reported outcome tools (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI]). Secondary outcomes: daytime sleepiness (Epworth Sleepiness Scale [ESS]), restless legs severity (International Restless Legs Syndrome Scale), health-related quality of life, psychological well-being, perceived fatigue, depression, anxiety, adverse events, and objective sleep parameters (accelerometry: cortisol, melatonin, serotonin biomarkers)."} | |
| {"review_pmid":"41065407","title":"Does resistance training improve pain intensity, quality of life, and disability in people with chronic nonspecific low back pain? A systematic review and meta-analysis","abstract":"Purpose: Systematic review with meta-analysis to evaluate the efficacy of resistance training (RT) in improving pain intensity, quality of life, and disability in people with nonspecific chronic low back pain (NSCLBP). Method: Searches were conducted in April 2025 using MEDLINE, Scopus, Web of Science, and the Cochrane Library. Randomized controlled trials (RCTs) that compared RT interventions with any treatment and assessed pain intensity, quality of life, or disability in adults with NSCLBP were included. A pairwise random-effects meta-analysis was performed by subgroup according to the comparison treatment. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool (RoB 2), and certainty of evidence was evaluated using the GRADE approach. Results: Ten RCTs (n=434) showed significant improvements in pain intensity (SMD=-1.15; 95% CI [-1.67, -0.62], p<0.0001), quality of life (SMD = 0.82; 95% CI [0.19, 1.46], p = 0.01), and disability (SMD=-2.76; 95% CI [-3.90, -1.62], p<0.00001) favoring RT. Only pain intensity reached clinical significance. The certainty of the evidence was rated as \"moderate\" for all variables. Conclusions: RT programs effectively reduce pain intensity and disability in patients with NSCLBP. Moderate certainty of evidence suggests that RT can be recommended for NSCLBP. Further research is required to confirm these findings. PROSPERO registration no.: CRD42024505897.","population":"Adults (≥18 years) diagnosed with chronic nonspecific low back pain (CNSLBP), defined as low back pain of non-specific origin with symptom duration >12 weeks. Excluded are individuals with specific secondary causes such as radicular pain, spinal stenosis, or other identifiable pathoanatomical diagnoses (e.g., fracture, malignancy, inflammatory arthritis).","intervention_or_exposure":"Resistance training (strength training) utilized as the sole primary intervention in any treatment arm, encompassing any modality (free weights, machines, elastic bands, lumbar extension machines), load intensity, frequency, and program duration, without combination with other treatment modalities.","comparator":"Any active or passive comparator treatment, including usual care, conventional physiotherapy, combined therapy (e.g., resistance training co-delivered with another modality), aerobic exercise, motor control exercise, cognitive-behavioral approaches, or no treatment/waitlist control.","outcome":"Primary outcomes: (1) pain intensity, assessed by validated scales (e.g., Visual Analogue Scale [VAS] or Numerical Rating Scale [NRS]); (2) health-related quality of life (e.g., SF-36); (3) functional disability (e.g., Roland Morris Disability Questionnaire [RMDQ], Oswestry Disability Index [ODI]). Clinical significance was defined as ≥15% improvement for pain and disability, and ≥10% for quality of life."} | |
| {"review_pmid":"41388744","title":"Antihypertensive Effects of Curcumin/Turmeric Supplementation in Prediabetes and Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials","abstract":"Introduction: Hypertension is a major cardiovascular risk factor in individuals with prediabetes and type 2 diabetes (T2D). Curcumin, with its anti-inflammatory and antioxidant properties, has emerged as a potential adjunct therapy, but its effect on blood pressure in this population remains unclear. Aims: This meta-analysis aimed to evaluate the effects of curcumin or turmeric supplementation on systolic (SBP) and diastolic (DBP) blood pressure in adults with prediabetes or T2D. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted until August 2025. Randomised controlled trials (RCTs) investigating curcumin/turmeric supplementation on blood pressure in adults with prediabetes or T2D were included. A meta-analysis was performed using a random-effects model. Results: Fifteen RCTs comprising 16 treatment arms (n=855 participants) were included. Pooled results indicated that curcumin/turmeric supplementation significantly reduced SBP (WMD: -2.69 mmHg; 95% CI: -3.84 to -1.55; p<0.001; I2=30.1%) compared to control groups. A more substantial reduction in SBP (-3.41 mmHg) was observed in the subgroup of participants with baseline hypertension (SBP ≥130 mmHg). However, no significant effect was found on DBP (WMD: -1.20 mmHg; 95% CI: -2.84 to 0.44; p=0.15; I2=84.3%). Subgroup analyses showed significant reductions in SBP in individuals with T2D or prediabetes, in those who were overweight, and with interventions using nano-curcumin, turmeric, or curcumin with piperine at doses >1 g/day. In addition, subgroup analysis showed that curcumin/turmeric supplementation led to a significant reduction in DBP in individuals with T2D. Conclusions: Curcumin/turmeric supplementation demonstrates a modest, yet significant reduction in SBP in individuals with prediabetes and diabetes, with a more pronounced effect in those with baseline hypertension. Further high-quality RCTs are needed to confirm these findings and establish optimal dosing.","population":"Adult human participants (≥18 years) with a confirmed diagnosis of prediabetes (impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes mellitus (T2D), including those who are overweight or obese, and those with or without co-existing hypertension (SBP ≥130 mmHg). Both sexes are eligible.","intervention_or_exposure":"Oral supplementation with curcumin, curcuminoids, turmeric (Curcuma longa), or any bio-enhanced/formulated derivative of curcumin, including nano-curcumin, phytosomal curcumin, and curcumin-piperine combination products, at any dose (ranging from 80 to 2100 mg/day) and for any duration (8 to 24 weeks), in parallel or crossover RCT design.","comparator":"Placebo (matched in appearance and taste to the active intervention) or conventional/standard pharmacological therapy (non-curcumin treatment, e.g., conventional antidiabetic drugs).","outcome":"Primary outcomes: changes from baseline in systolic blood pressure (SBP, mmHg) and diastolic blood pressure (DBP, mmHg). Prespecified subgroup analyses were conducted by health status (prediabetes vs. T2D), geographical region, curcumin formulation type, daily dose (≤1 g/day vs. >1 g/day), intervention duration (<12 weeks vs. ≥12 weeks), baseline BMI category, and baseline blood pressure level (SBP <130 mmHg vs. ≥130 mmHg; DBP <80 mmHg vs. ≥80 mmHg)."} | |
| {"review_pmid":"41507873","title":"Association between green space exposure and elderly health: a systematic review and meta-analysis","abstract":"Background: Exposure to green spaces is associated with many health benefits across various stages of life. However, no comprehensive synthesis currently exists to consolidate this evidence into a systematic body of knowledge that captures the overall impact of exposure to green space on the health of older adults. This systematic review seeks to address this gap by generating a thorough, integrated evidence base and offering valuable insights for future research directions and practical applications. Methods: We adopted an extensive search strategy, drawing from multiple electronic databases as well as the National Institute for Health and Clinical Excellence (United Kingdom) and the Guidelines International Network. The electronic databases searched included the Cochrane Library, Medline, Embase, CINAHL, PubMed, Web of Science, Scopus, Global Health, and CNKI, using the PEOS search framework. The search encompassed publications from the inception of each database to November 2024. A total of 5,749 records were initially identified, and, following a dual-reviewer screening and selection process, 27 studies were ultimately included in the review. Results: Exposure to green spaces was associated with effects on circulatory system disorders, mental health conditions, nervous system diseases, cognitive decline, metabolic disorders, and overall life satisfaction in older adults. Evidence regarding cardiovascular outcomes was mixed, with some studies indicating a U-shaped relationship for hypertension. Exposure to green space demonstrated a protective role against metabolic diseases and was positively associated with enhanced life satisfaction among older adults. Meta-analyses revealed that exposure to green space was associated with a lower risk of Alzheimer's disease (OR = 0.856, 95% CI: 0.769-0.943) and depression (OR = 0.724, 95% CI: 0.549-0.900). Conclusions: This systematic review synthesizes the multifaceted health effects of green environments on ageing populations, critically evaluating empirical evidence on exposure to green space and health outcomes in older adults. The findings present a robust, evidence-based framework that underscores consistent associations between the accessibility and quality of green spaces and key indicators of geriatric health, thereby laying the groundwork for designing targeted, nature-based behavioral interventions. Trial registration: PROSPERO (CRD42024619700).","population":"Community-dwelling older adults aged 60 years and above, without restriction by sex, geography, language, or baseline health condition, as included in observational studies and the one eligible randomized trial.","intervention_or_exposure":"Exposure to green space, operationalized through the degree of greenness exposure (e.g., NDVI), types of greenery (parks, vegetated areas, forests, open green spaces), and green-space accessibility or self-reported access. This is an exposure rather than a therapeutic intervention.","comparator":"Lower, absent, or reference-category green-space exposure, including lower NDVI/greenness availability, poorer access, fewer or less proximate green spaces, or the least-exposed category within the original observational study.","outcome":"Health outcomes in older adults, including respiratory tract diseases, cardiovascular diseases such as coronary heart disease and hypertension, metabolic disorders such as diabetes, osteoporosis and dyslipidemia, nervous-system diseases such as stroke, sarcopenia and sleep-wake disorders, mental disorders such as anxiety, depression, schizophrenia and cognitive impairment, isolation, life satisfaction, subjective well-being, Alzheimer disease, and depression."} | |
| {"review_pmid":"41531667","title":"Ambient Temperature and Risk of Renal Colic: A Systematic Review and Meta-analysis","abstract":"Rationale & Objectives: Extreme ambient temperatures have been associated with a higher risk of acute and chronic health outcomes, including cardiovascular, respiratory, infectious, and kidney diseases. However, there is a lack of synthesized comprehensive evidence regarding the association of ambient temperature and renal colic in existing literature. Study Design: Systematic review and meta-analysis of epidemiological studies. Setting & Population: Population of any geographic areas regardless of their age, sex/gender, ethnicity, or any other population characteristics. Selection Criteria for Studies: Literature searches were conducted in PubMed, Scopus, CINAHL Complete, Web of Science, and additional sources until June 4, 2024, following the Population-Exposure-Comparator-Outcome (PECO) framework. Exposure: Daily ambient temperature. Outcomes: Confirmed cases of renal colic, including underlying causes such as kidney stone/nephrolithiasis or urolithiasis, urinary tract infection, and pyelonephritis. Analytical Approach: Random-effects meta-analyses using the DerSimonian and Laird method. Results: Of 982 initially retrieved articles, 26 articles were included in the systematic review, of which 23 were eligible for the heat effect meta-analysis and 7 were included in the cold effect meta-analysis. Despite high heterogeneity, the result showed a 2.4% higher risk of renal colic for 1 C higher daily ambient temperature (Cohen's d, 0.013 [95% CI, 0.010-0.015]; RR, 1.024 [95% CI, 1.020-1.028]). For a 1 C lower daily ambient temperature, the risk of renal colic was 1.5% (Cohen's d, 0.008 [95% CI: -0.000 to 0.016]; RR, 1.015 [95% CI, 1.000-1.029]), although not statistically significant. Limitations: Limitations include high heterogeneity and publication bias. Conclusions: Elevated daily ambient temperature is associated with the risk of renal colic, suggesting an adverse effect of high ambient temperature on kidney function. Registration: PROSPERO CRD42024555579.","population":"Human populations from any geographic area, irrespective of age, sex/gender, ethnicity, or other population characteristics, evaluated in cohort/longitudinal or other epidemiological study designs.","intervention_or_exposure":"Exposure to measurable daily mean ambient temperature in degrees Celsius, including temperatures above or below a reference temperature, extreme heat or cold conditions defined by percentiles, and heat or cold waves persisting for days. This is an exposure rather than a therapeutic intervention.","comparator":"People or person-time not exposed to the same temperature as the exposure group, or the same population during periods when it was not exposed to the same ambient temperature; reference temperatures were used for heat/cold contrasts in nonlinear models.","outcome":"Confirmed renal colic outcomes and underlying causes, including kidney stone, nephrolithiasis, urolithiasis, urinary calculus, urinary tract infection, and pyelonephritis, based on ICD codes or the case definitions used in the included articles; eligible studies reported quantitative association measures such as RR, OR, or IRR."} | |
| {"review_pmid":"41561801","title":"Effect of exercise on abdominal obesity and inflammatory response in the older adults: a systematic review and meta-analysis of randomized controlled trials","abstract":"Background: Abdominal obesity and chronic inflammation are key indicators of aging, associated with various age-related diseases. While exercise is thought to mitigate these issues, its specific effects on abdominal obesity, adiponectin, and inflammatory markers in older adults need further exploration. Objective: This systematic review and meta-analysis aimed to evaluate the effects of exercise on abdominal obesity, adiponectin, and inflammation markers in older adults. Methods: A search was conducted up to February 20, 2025, using six electronic databases (Medline, Web of Science, Embase, CINAHL, Scopus, and Cochrane). The inclusion criteria focused on randomized controlled trials assessing exercise interventions in healthy older adults or those with obesity, diabetes, or metabolic syndrome. Relevant citations were analyzed using Rayyan software, while the quality of studies was assessed with the Cochrane risk of bias tool, and data were meta-analyzed using Review Manager 5.4 software. Results: From 7,622 citations, 128 articles were screened for full text, resulting in 19 RCTs with 1,130 participants included. Exercise significantly reduced abdominal obesity, demonstrated by a decrease in waist circumference (MD = -2.03 cm) and body mass index (MD = -0.49 kg/m2). Exercise also lowered CRP, TNF-alpha, and IL-6. Subgroup findings suggested greater waist-circumference reductions in obese older adults and those with metabolic syndrome, greater TNF-alpha lowering with vigorous physical activity, and different patterns by intervention duration. No significant changes in adiponectin levels were observed. Conclusion: Exercise has a positive effect on abdominal obesity in older adults and reduces levels of several inflammatory markers. Further randomized controlled trials are needed to better understand effects on other inflammatory markers. Systematic Review Registration: PROSPERO CRD42023404011.","population":"Older adults aged 60 years and above, including studies calculated by mean age, regardless of gender or health status, including healthy older adults and those with chronic conditions such as obesity, diabetes, or metabolic syndrome.","intervention_or_exposure":"Exercise interventions delivered in randomized controlled trials, including aerobic exercise, resistance training, combined aerobic and resistance programs, progressive resistance training, Tai Chi, Yi Jin Jing plus resistance training, circuit training, and other structured exercise programs varying in frequency, duration, and intensity.","comparator":"Non-exercise control conditions, maintenance of usual lifestyle or physical activity, usual care, sham/light exercise controls, or other comparator groups without the active exercise program under evaluation.","outcome":"Abdominal obesity and body-composition indicators including waist circumference, BMI, body fat percentage, and visceral fat area; inflammatory and adipokine markers including CRP, TNF-alpha, IL-6, adiponectin, leptin, IL-1beta, IL-8, IL-10, and related laboratory biomarkers."} | |
| {"review_pmid":"41566983","title":"Association of Particulate Matter (PM2.5) With COVID-19 Infection and Mortality in Low-and Middle-income Asian Countries: A Systematic Review and Meta-analysis","abstract":"Objectives: Low-income and middle-income countries in Asia bear a disproportionate burden of particulate matter with an aerodynamic diameter of 2.5 micrometers or less (PM2.5) pollution, yet data remain scarce. This systematic review and meta-analysis aimed to quantify the association between PM2.5 exposure and the risks of coronavirus disease 2019 (COVID-19) infection and mortality in this vulnerable region. Methods: A systematic search was conducted in PubMed, Scopus, and other major databases for studies published up to December 31, 2024. Observational studies reporting associations between PM2.5 and COVID-19 outcomes in low-income and middle-income Asian countries were included. Pooled effect sizes and 95% confidence intervals were calculated using a random-effects model. The study was registered with PROSPERO (CRD42022316008). Results: Fourteen studies met the inclusion criteria. Separate analyses demonstrated statistically significant positive associations between PM2.5 exposure and COVID-19 infection for both short-term exposure (pooled RR, 1.12; 95% CI, 1.07 to 1.18) and long-term exposure (pooled RR, 1.41; 95% CI, 1.28 to 1.56). For mortality, the analysis identified a statistically non-significant positive association with short-term exposure (pooled RR, 1.37; 95% CI, 0.80 to 2.33). Substantial heterogeneity was observed across analyses, but sensitivity analyses confirmed that infection findings were robust. Conclusions: PM2.5 exposure is a significant risk factor for COVID-19 infection in low-income and middle-income Asian countries. The available evidence was insufficient to establish a clear association with mortality. These results underscore the need for strengthened air quality control policies as part of public health strategies to mitigate respiratory pandemics.","population":"Human populations or area-level populations in Asian countries classified by the World Bank as low-, lower-middle-, or upper-middle-income countries, with studies reporting COVID-19 infection or mortality outcomes.","intervention_or_exposure":"Outdoor ambient PM2.5 exposure. Short-term exposure was defined as daily or weekly PM2.5 concentrations, and long-term exposure as average PM2.5 concentrations measured over several months or years.","comparator":"Lower or reference PM2.5 exposure levels, including lower-exposure periods or areas within the same study, or the least-exposed/reference category used to estimate RR, OR, or HR.","outcome":"COVID-19 infection outcomes, including cases or incidence, and COVID-19 mortality outcomes, including deaths or case-fatality rates, with quantitative effect estimates and 95% confidence intervals."} | |
| {"review_pmid":"41601519","title":"Effectiveness of unguided digital cognitive behavioral therapy for insomnia on depressive symptoms: a systematic review and meta-analysis of randomized controlled trials","abstract":"Objective: This study aimed to assess the intervention effects of unguided digital cognitive behavioral therapy for insomnia (dCBT-I) on patients with comorbid depression and insomnia through a systematic review and meta-analysis, in order to determine its effectiveness as a treatment strategy for comorbid depression and insomnia. Methods: A systematic search across PubMed, Cochrane, Embase, ClinicalTrials.gov, and PsycINFO was conducted to identify randomized controlled trials focusing on adults with comorbid insomnia and depressive symptoms, excluding those with severe physical illnesses or psychiatric disorders. Following duplicate removal, 1842 articles were screened, resulting in 16 RCTs in the final meta-analysis. Results: Post-treatment evaluations revealed that dCBT-I demonstrated a significant impact on insomnia (SMD = -0.94; 95% CI: -1.40 to -0.48) and depressive symptoms (SMD = -0.63; 95% CI: -0.81 to -0.46), with high heterogeneity. Strong outcomes were observed in both web and app cohorts, with notable findings in the moderately depressed subgroup. Conclusions: This meta-analysis evaluated therapist-unguided dCBT-I for insomnia and depression. Unguided dCBT-I demonstrated significant reductions in insomnia severity and depressive symptoms within the studied population, despite substantial heterogeneity, and showed moderate-to-large effects for moderate-to-severe depression. Systematic Review Registration: PROSPERO CRD420251044042.","population":"Adults aged 18 years and older with clinician-diagnosed or symptomatic insomnia according to DSM or ICSD criteria and depressive symptoms. Studies with severe physical illness, substance abuse, organic or primary sleep disorders such as sleep apnea or restless legs syndrome, bipolar disorder, schizophrenia, neurological disorders, acute suicide risk, severe cognitive impairment, or pregnancy were excluded.","intervention_or_exposure":"Unguided digital cognitive behavioral therapy for insomnia delivered by computer, internet, or app, incorporating at least one cognitive component such as cognitive restructuring and at least one behavioral component such as stimulus control or sleep restriction, without therapist guidance.","comparator":"Placebo, active control, waitlist control, standard care, sleep education, general health education, routine treatment, or other non-dCBT-I control conditions.","outcome":"Depressive symptoms measured with validated scales such as HAMD or PHQ-9; insomnia severity and sleep outcomes including ISI, SCI, SLEEP-50, sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time."} | |
| {"review_pmid":"41617837","title":"Associations of heat exposure with mental health and suicide in children and adolescents: a systematic review and meta-analysis","abstract":"Limited evidence exists on the association between high temperature and mental health in younger age group. A systematic search on PubMed, Web of Science, CINAHL Plus and PsycInfo was conducted, and studies exploring associations of heat exposure with mental health and suicide among children and adolescents (<=24 years) were reviewed. Twenty-eight observational studies published over 2007-2025 were included for systematic review. Exposure to high temperature was associated with 13% higher risk of hospital visits or hospitalizations for mental health disorders, 14% higher risk for schizophrenia, 18% higher risk for depression, and 12% higher risk for composite mental health illnesses, relative to low temperature. Each 1 C increment in temperature was associated with 1.0% higher risk of suicide. Findings suggest the need for early-life interventions and evidence-based adaptation policies for preventing climate-induced mental illnesses and suicide. Optimizing policies will be important for high- and upper-middle-income countries, while more scientific evidence from lower-income economies is warranted.","population":"Children, adolescents, and young people aged 24 years or younger, including adolescents defined as individuals aged 10 to 24 years, with independent analyses reported for this age group.","intervention_or_exposure":"High outdoor temperature or ambient heat exposure, including heat extremes, high versus low temperature definitions, percentile-based high-temperature thresholds, humidex, and continuous temperature increments. This is an environmental exposure rather than a therapeutic intervention.","comparator":"Low outdoor temperature, lower percentile/reference temperature, minimum morbidity temperature, or other study-specific low/reference exposure category.","outcome":"Mental health sequelae and suicide outcomes, including hospital visits or hospitalizations for mental health disorders, schizophrenia or other psychotic disorders, depression, anxiety, composite mental health illnesses, self-inflicted injury, suicidal mortality, and suicide defined by ICD codes."} | |
| {"review_pmid":"41639651","title":"Association between PM2.5 exposure and blood pressure among young adults in Asia: systematic review and meta-analysis","abstract":"Background: Ambient air pollution, particularly fine particulate matter (PM2.5), and hypertension are compounding public health challenges in low- and middle-income countries. Although several studies have explored the relationship between ambient air pollution and blood pressure, evidence remains limited for young adults. This systematic review and meta-analysis investigated associations between PM2.5 exposure and blood pressure among young adults residing in Asia. Methods: PubMed, Embase, and Scopus were searched for studies published up to December 2024. Eligible studies reported associations between PM2.5 and blood pressure in populations aged 18-45 years. Data were extracted on study characteristics and effect estimates. Pooled mean changes in systolic blood pressure and diastolic blood pressure per 10 micrograms/m3 increase in PM2.5 were calculated using a random-effects model. Subgroup and sensitivity analyses explored heterogeneity and study influence. Results: Of 177 articles screened, 11 met the inclusion criteria. Each 10 micrograms/m3 increase in PM2.5 was associated with a 1.13 mmHg rise in SBP and a 0.38 mmHg rise in DBP. Subgroup analysis indicated that long-term exposure was significantly associated with elevated DBP. Conclusion: Both short-term and long-term PM2.5 exposure were positively associated with blood pressure among young adults, highlighting novel evidence for an overlooked population and the need for targeted interventions and stricter air quality standards. Trial registration: PROSPERO CRD42025642716.","population":"Young adults aged 18-45 years residing in Asia, including dedicated young adult cohorts and general-population studies with age-stratified young-adult results.","intervention_or_exposure":"Ambient PM2.5 exposure, including short-term exposure within 30 days and long-term exposure longer than 6 months; exposure estimates could be ambient or personal monitoring when they primarily captured ambient PM2.5 variation.","comparator":"Lower or reference PM2.5 exposure, expressed through within-study effect estimates standardized to a 10 micrograms/m3 increase; cross-over, randomized, indoor/household pollution, and no-age-stratified child/older-adult studies were excluded.","outcome":"Systolic blood pressure and diastolic blood pressure, reported as beta estimates with 95% confidence intervals or sufficient data to calculate these estimates."} | |
| {"review_pmid":"41639864","title":"Association between aerobic exercise and vascular endothelial growth factor (VEGF) concentration in adults: a systematic review and meta-analysis of randomized controlled trials","abstract":"Purpose: This systematic review and meta-analysis aimed to assess the effect of aerobic exercise on circulating vascular endothelial growth factor (VEGF) levels in adults, given inconsistent results in randomized controlled trials. Methods: ISI Web of Science, PubMed/MEDLINE, and Scopus were searched up to May 2025. Thirteen RCTs satisfied eligibility criteria. Random-effects meta-analysis estimated the overall standardized mean difference in VEGF between aerobic exercise and control groups. Subgroup analyses were conducted based on exercise intensity, duration, and biological sample type. Results: Pooled analysis demonstrated no significant overall effect of aerobic exercise on circulating VEGF levels (SMD = -0.075; 95% CI: -0.246 to 0.096). Reductions in VEGF levels occurred in studies using interventions lasting 8 weeks or less. Evidence certainty was rated very low. Conclusions: Aerobic exercise does not appear to have a significant overall influence on circulating VEGF levels, although VEGF reductions may occur after short-duration interventions. Larger high-quality RCTs are needed to verify these associations and explore mechanisms.","population":"Adults aged 18 years and older enrolled in randomized controlled trials, including healthy populations, patients with cardiovascular disease, patients with solid tumors, and other adult clinical groups; trials in children or adolescents were excluded.","intervention_or_exposure":"Aerobic exercise interventions of at least 4 weeks, including cycling, treadmill walking, stationary bike, Taekwondo, ergometer bike/row, and other aerobic training programs, with varying frequency, duration, intensity, and intervention length.","comparator":"Sedentary or no-exercise control groups, diet-only controls when the aerobic exercise effect could be isolated, or other control arms without the active aerobic exercise intervention.","outcome":"Circulating vascular endothelial growth factor (VEGF) protein concentration measured in serum or plasma, reported as mean changes and standard deviations or sufficient data to calculate effect sizes."} | |
| {"review_pmid":"41652340","title":"Evidence gaps in the effects of exercise on SASP-Related biomarkers in older adults: a systematic review and meta-analysis of randomized controlled trials","abstract":"Background: Cellular senescence is a hallmark of aging, characterized by secretion of proinflammatory factors known as the senescence-associated secretory phenotype (SASP). While physical exercise is proposed as a potential modulator of cellular aging, its effect on specific senescence biomarkers in older adults remains unclear. Methods: A systematic review and meta-analysis following PRISMA guidelines was conducted (PROSPERO CRD42024623676). Randomized controlled trials involving participants aged 60 years or older were included if they compared structured exercise interventions with control conditions and reported biomarkers of cellular senescence. A Bayesian meta-analysis was performed, and risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Three RCTs (n = 1447; age range 66-79; 64.2% female) met the inclusion criteria. Two were eligible for meta-analysis, focusing on SASP-related cytokines (CCL2, IL-6, IL-8, TNF-alpha). No statistically significant differences were observed between exercise and control groups. One excluded study reported increased SIRT levels following resistance training, but these are not standard senescence markers. None of the included RCTs evaluated key upstream markers such as p16INK4a or p21. Conclusions: This review found no conclusive evidence that exercise training affects canonical markers of cellular senescence in older adults. The biomarkers analyzed were limited to SASP-related cytokines, which reflect downstream inflammation rather than primary senescence regulation. Future studies should use standardized protocols to evaluate upstream markers such as p16INK4a and p21.","population":"Older adults aged 60 years and above, without restrictions on sex or ethnicity, enrolled in randomized controlled trials reporting senescence-related biomarkers.","intervention_or_exposure":"Structured exercise programs, including resistance/strength training, endurance/aerobic training, and combined exercise interventions, with interventions lasting from six weeks to three years in the included trials.","comparator":"Usual care controls, standard care consisting of health education and maintenance of usual lifestyle, or controls undergoing alternative interventions.","outcome":"Biomarkers of cellular senescence, especially SASP-related cytokines measured in blood-derived samples such as serum or plasma, including CCL2, IL-6, IL-8, and TNF-alpha; upstream markers such as p16INK4a and p21 were sought but not reported by included RCTs."} | |
| {"review_pmid":"41656984","title":"Effectiveness of Health Coaching Interventions on Anxiety, Depression, Self-Management Behaviors, Self-Efficacy, and Quality of Life Among Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","abstract":"Background: Health coaching has emerged as a promising intervention to improve health outcomes in older adults. However, its effectiveness has not been comprehensively synthesized. Aim: To evaluate the effectiveness of health coaching interventions on anxiety, depression, quality of life, self-management behavior, and self-efficacy among older adults. Methods: A systematic search of six English databases (PubMed, Scopus, CINAHL, Cochrane Library, APA PsycInfo, and ProQuest Dissertations & Theses Global) was conducted from inception to October 20, 2024. Standardized mean difference and 95% confidence interval were calculated using meta-analysis with random or fixed effects. Sensitivity analyses, subgroup analyses, and publication bias tests were performed. Results: Thirty-five RCTs involving 20,200 older adults were included. Health coaching interventions significantly improved anxiety, quality of life, self-management behaviors, and self-efficacy among older adults, but had no significant effects on depression. Linking Evidence to Action: Health coaching interventions may enhance the well-being of older adults. However, certainty of evidence was generally very low to moderate, and substantial heterogeneity existed across studies. More high-quality RCTs with extended follow-up and analyses of differential effects across demographic information are needed.","population":"Older adults aged 60 years and over, based on average or median minimum age, including community-dwelling older adults and older adults with chronic conditions such as COPD, diabetes, cancer, CKD, heart failure, peripheral arterial disease, and other long-term conditions.","intervention_or_exposure":"Health coaching interventions including goal setting, empowerment or motivational interviewing/coaching-style communication, and health education, delivered remotely, face-to-face, or in mixed formats by nurses, health coaches, physicians, therapists, dietitians, or other interventionists.","comparator":"Usual care, waitlist control, educational programs, physical activity counseling, attention control, or other non-health-coaching interventions; comparator interventions that included health coaching were excluded.","outcome":"Anxiety, depression, quality of life, self-management behaviors, self-efficacy, and patient activation, excluding studies focused only on feasibility, acceptability, cost-benefit, or component-specific quality-of-life measures without overall quality of life."} | |
| {"review_pmid":"41721779","title":"Effects of inspiratory muscle training on obstructive sleep apnea: a systematic review and meta-analysis","abstract":"Rationale: Inspiratory muscle training (IMT) is a relatively new intervention for obstructive sleep apnea (OSA), with the aim of improving respiratory muscle strength and mitigating OSA-related symptoms. However, its effects on key clinical endpoints remain unclear. Objectives: To evaluate the effects of IMT on OSA severity, sleep quality, respiratory function, and cardiovascular outcomes. Methods: We systematically searched PubMed, EMBASE, CENTRAL, and Web of Science for randomized controlled trials (RCTs) assessing IMT in adults with OSA. Studies assessed IMT vs control/placebo with outcomes, including the apnea-hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), maximal inspiratory pressure (MIP), lowest oxygen saturation (LSaO2), blood pressure (BP), and body mass index (BMI). Results: Ten RCTs (166 IMT vs 157 control participants) found significant improvements in OSA with IMT across multiple domains. The intergroup difference in mean BMI reduction (mean difference [MD], -1.48; 95% credible interval [CI], -2.39 to -0.57), mean PSQI gain (-3.15; -3.69 to -2.62), mean LSaO2 gain (2.86; 1.01 to 4.71), mean ESS reduction (-3.18; -4.50 to -1.87), mean MIP gain (25.54; 11.09 to 40.00), the percentage of predicted values for forced vital capacity predicted gain (17.20; 9.53 to 24.87), and mean systolic blood pressure reduction (-6.63; -13.26 to -0.00) indicated the benefit of IMT over the control therapy. However, there was no significant improvement in AHI (1.00; -2.57 to 4.56). Heterogeneity primarily stemmed from differences in intervention protocols and baseline disease severity among the patients. Conclusions: Inspiratory muscle training resulted in clinically meaningful symptomatic benefits across OSA phenotypes by enhancing respiratory strength, sleep quality, and cardiovascular health. However, the lack of significant improvement in AHI suggests that IMT may not affect primary pathophysiological markers of OSA. Thus, IMT may be an adjunctive intervention, rather than a primary therapy, for reducing event frequency in OSA.","population":"Adult patients (≥18 years) with suspected or confirmed obstructive sleep apnea (OSA), defined by an apnea-hypopnea index (AHI) ≥5 events/hour as identified by polysomnography per American Academy of Sleep Medicine recommendations, across all OSA phenotypes and baseline disease severity levels.","intervention_or_exposure":"Standalone inspiratory muscle training (IMT) used as an independent therapeutic intervention without combination with other treatment modalities (e.g., CPAP, mandibular advancement devices, positional therapy, weight loss programs). Any training protocol is eligible, including any intensity (expressed as percentage of maximal inspiratory pressure [MIP]), frequency (sets, breaths, sessions per day/week), and intervention duration.","comparator":"Sham IMT (low-load inspiratory training, typically ≤15–20% of MIP, providing minimal respiratory muscle stimulus) or no intervention (standard care without any IMT).","outcome":"Primary outcome: apnea-hypopnea index (AHI, events/hour). Secondary outcomes: body mass index (BMI, kg/m²), neck circumference (NC, cm), Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE, %), lowest nocturnal oxygen saturation (LSaO2, %), Epworth Sleepiness Scale (ESS), maximal inspiratory pressure (MIP, cmH₂O), maximum expiratory pressure (MEP, cmH₂O), forced vital capacity (FVC, % predicted), FEV1/FVC ratio, FEV1%, systolic blood pressure (SBP, mmHg), diastolic blood pressure (DBP, mmHg), heart rate (HR, bpm), and plasma norepinephrine (PNE)."} | |
| {"review_pmid":"41743679","title":"Effects of aquatic exercise on improving body composition and muscle strength in the older adults: a systematic review and meta-analysis of randomized controlled trials","abstract":"Background: Due to challenges posed by aging such as decreased physical abilities and higher susceptibility to chronic illnesses, effective exercise interventions are crucial for older individuals. Despite potential benefits of aquatic exercise, robust evidence supporting efficacy is limited. This systematic review and meta-analysis assessed the impact of aquatic exercise on muscle strength, body composition, and related physical and metabolic indicators in older adults. Methods: Seven databases were searched from inception to August 1, 2025. The analysis included 19 RCTs (n = 866 participants) and followed PRISMA guidelines. Meta-analyses and meta-regressions assessed outcomes, heterogeneity, risk of bias, and certainty of evidence. Results: Aquatic exercise significantly enhanced muscle strength and flexibility in older adults, improved functional mobility measured by Timed Up and Go, and reduced body fat percentage and total cholesterol. It did not significantly affect body weight, BMI, HDL-C, LDL-C, or triglycerides. Conclusion: Aquatic exercise may be a viable intervention for preserving muscle function, flexibility, and lipid homeostasis in older adults, offering a perspective on maintaining functional independence. Larger multicenter studies with long-term follow-up are needed to validate metabolic benefits and safety. Systematic review registration: CRD42024568443.","population":"Healthy older adults aged 60 years and above, with Aboriginal and Torres Strait Islander peoples considered older adults from age 50 years, according to the review eligibility criteria.","intervention_or_exposure":"Aquatic exercise programs, including swimming, non-swimming water exercise, water-based exercise, water resistance exercise, water walking, and similar aquatic interventions, with no restrictions on type, frequency, intensity, or duration.","comparator":"Land-based exercise, usual daily activities, sedentary control, no exercise therapy, or other non-aquatic control groups.","outcome":"Primary outcomes: muscle strength measures such as grip strength, 30-second chair stand test, and arm curl test, and body-composition/metabolic measures such as body fat mass, HDL-C, LDL-C, and total cholesterol. Secondary outcomes: flexibility, mobility such as Timed Up and Go, body weight, BMI, waist-to-hip ratio, anthropometric measures, and triglycerides."} | |
| {"review_pmid":"41761990","title":"Effects of Curcumin/Turmeric Supplementation on Kidney Function in Individuals With Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials","abstract":"Background: Curcumin and turmeric are widely studied for their potential renoprotective effects, but evidence regarding their impact on kidney function in individuals with diabetes remains inconsistent. Objective: To systematically evaluate the effects of curcumin/turmeric supplementation on kidney function parameters in subjects with diabetes. Methods: PubMed, Web of Science and Scopus were searched from inception until August 2025. Randomised controlled trials (RCTs) assessing the effects of curcumin/turmeric on serum creatinine, blood urea nitrogen (BUN), uric acid, urea and albumin in diabetic populations were included. Data were pooled using random-effects models and reported as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Subgroup, sensitivity, and meta-regression analyses were conducted. Risk of bias was assessed using the Cochrane RoB 2 tool, and evidence certainty was evaluated via GRADE. Results: Twelve RCTs (n=1303 participants) were included. Curcumin/turmeric supplementation did not significantly affect creatinine (WMD: -0.01 mg/dL, 95% CI: -0.03 to 0.01, p=0.519) or BUN (WMD: -0.41 mg/dL, 95% CI: -3.15 to 2.33, p=0.769). A trend toward reduction in uric acid was observed (WMD: -1.46 mg/dL, 95% CI: -2.93 to 0.02, p=0.053). However, urea levels were significantly reduced (WMD: -2.53 mg/dL, 95% CI: -4.09 to -0.96, p=0.002). No significant change was found in albumin (WMD: 0.07 g/dL, 95% CI: -0.02 to 0.17, p=0.133). Subgroup analyses showed no significant moderating effects. Publication bias was detected for creatinine (Egger's p=0.028). The certainty of evidence was moderate for creatinine, urea, and albumin, and low for BUN and uric acid. Conclusion: Curcumin/turmeric supplementation significantly reduces urea levels but does not significantly affect creatinine, BUN, uric acid or albumin in individuals with diabetes. Further high-quality, long-term RCTs are needed to clarify its renoprotective potential and optimal dosing.","population":"Adult human subjects (≥18 years) with a confirmed diagnosis of type 1 or type 2 diabetes mellitus, with or without pre-existing established kidney disease (including diabetic nephropathy, proteinuric chronic kidney disease [CKD], or impaired baseline renal function). Both sexes are included, and no restriction is placed on diabetes duration or glycemic control status.","intervention_or_exposure":"Oral supplementation with curcumin, turmeric (Curcuma longa), or any curcuminoid-based formulation, regardless of dose (ranging from 80 to 2000 mg/day), duration (4 to 48 weeks), or formulation type, including unformulated curcumin, piperine-enhanced curcumin, nano-curcumin, turmeric powder, and phytosomal curcumin. Trials administering curcumin intravenously, topically, or as part of a multi-component supplement where the curcumin effect cannot be isolated are excluded.","comparator":"Placebo (matched in appearance to the active intervention, without curcumin content) or active control (e.g., conventional pharmacological therapy for diabetes or CKD management).","outcome":"Changes in serum kidney function biomarkers from baseline to end of intervention: (1) serum creatinine (mg/dL, primary outcome); (2) blood urea nitrogen (BUN, mg/dL); (3) serum uric acid (mg/dL); (4) serum urea (mg/dL); (5) serum albumin (g/dL). Subgroup analyses were prespecified by baseline creatinine level, intervention duration, dose, formulation type, and kidney disease status."} | |
| {"review_pmid":"41830012","title":"Complex Effects of B-Vitamin Combinations on Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials over Three Decades","abstract":"Background and Purpose: The effects of B-vitamin combinations on the prevention of cardiovascular diseases, such as myocardial infarction (MI) and stroke, remain controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) over three decades to evaluate the association between B-vitamin combinations and mortality and arterial thrombotic outcomes. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for RCTs with minimal duration over 24 months published between January 1996 and November 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects models were used in this meta-analysis to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Results: Thirteen randomized trials enrolling 68,363 participants across both primary and secondary prevention populations were included. B-vitamin combinations were associated with a nonsignificant reduction in stroke and 3-point major adverse cardiovascular events (MACE) (stroke: RR 0.91, 95% CI 0.81-1.04; MACE: RR 0.93, 95% CI 0.86-1.01). No significant effects were observed for all-cause mortality (RR 1.01, 95% CI 0.96-1.06), cardiovascular mortality (RR 0.97, 95% CI 0.88-1.07), or MI (RR 0.97, 95% CI 0.91-1.03). In primary prevention populations, B-vitamin combinations were associated with significant reductions in stroke (RR 0.79, 95% CI 0.68-0.93) and MACE (RR 0.80, 95% CI 0.69-0.92). A modest reduction in MACE was also observed in secondary prevention populations (RR 0.91, 95% CI 0.83-0.99). Between-study heterogeneity was minimal to low for ischemic outcomes, supporting the robustness of these estimates, whereas substantial heterogeneity was observed for mortality outcomes in secondary prevention populations. Conclusions: The evidence is limited by heterogeneity in trial populations, vitamin formulations and doses, and outcome definitions, with substantial between-study inconsistency for mortality outcomes and imprecision in subgroup estimates derived from a small number of contributing trials. Overall, B-vitamin combinations do not confer consistent benefit for major cardiovascular outcomes but may reduce stroke and MACE in selected primary prevention populations, suggesting that baseline cardiovascular risk and regional folic acid fortification modify treatment effects and should guide future trial design and clinical use.","population":"Adult patients (≥18 years) in both primary prevention populations (without pre-existing cardiovascular disease, with low ASCVD risk <7.5%) and secondary prevention populations (with established cardiovascular disease, including coronary artery disease, prior stroke/TIA, kidney transplant recipients, or diabetes with high ASCVD risk ≥20%), with a minimum follow-up duration >24 months. Trials enrolling mixed primary and secondary prevention populations are also included.","intervention_or_exposure":"Oral, enteral, or parenteral supplementation with combinations of B-vitamins, specifically folic acid (vitamin B9), cobalamin (vitamin B12), and/or pyridoxine (vitamin B6), in any formulation (tablet, capsule, injectable), dosage, or combination regimen targeting homocysteine-lowering pathways.","comparator":"Placebo (matched in appearance without active B-vitamin content) or B-vitamin formulations provided at doses lower than the recommended daily allowance (RDA) as comparator.","outcome":"Incidence of arterial thrombotic and cardiovascular outcomes: stroke (ischemic or unspecified) and transient ischemic attack (TIA); myocardial infarction (MI, fatal and nonfatal); unstable angina; cardiovascular accident (CVA); composite 3-point major adverse cardiovascular events (MACE: cardiovascular death + nonfatal MI + nonfatal stroke); all-cause mortality; and cardiovascular disease-specific mortality. Subgroup analyses by primary vs. secondary prevention status and estimated ASCVD risk."} | |
| {"review_pmid":"41835126","title":"Heat Exposure and Health Outcomes in Construction Workers: A Systematic Review and Meta-Analysis","abstract":"Climate change is becoming a recognized health concern in the scientific community, as heat exposure poses escalating health risks to outdoor occupational groups, particularly construction workers. Heat stress and climate change may lead to adverse physical health outcomes and reduced workability among construction workers. This systematic review and meta-analysis aimed to (1) examine the prevalence of physical health outcomes of construction workers in relation to heat exposure and (2) analyze the association between physical health outcomes of heat exposure and work performance by sex and age. Following PRISMA guidelines and using a PICO framework, a comprehensive search was conducted across APA PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science. Seventeen studies met the inclusion criteria. Outcomes were grouped into dehydration, heat-related illnesses, kidney function impairments, and heat-related deaths. Random-effects models were used, and subgroup analyses were performed using demographic variables. Pooled meta-analysis and heterogeneity statistics were only provided for the HRI outcome, as other outcomes were represented by single eligible studies. Dehydration demonstrated the highest single-study prevalence, contrasting with pooled HRI prevalence and kidney function impairment single-study prevalence. Heat exposure significantly impairs the physical health of construction workers, particularly through dehydration and heat-related illnesses. Sex-responsive, psychological, and intervention-based studies are essential for protecting this vulnerable occupational group from accelerating climate change.","population":"Adults of working age (18-65 years) employed in outdoor construction settings, referred to as construction workers, without geographical setting restrictions.","intervention_or_exposure":"Heat exposure, including extreme heat, heat stress, heat strain, heat exhaustion, heat stroke, environmental or passive heat exposure, and work-related heat strain arising from physical exertion and protective equipment. This is an occupational exposure rather than a therapeutic intervention.","comparator":"The original PICO table stated that no comparison was required for inclusion; for AutoMeta compatibility, the comparator is lower or absent heat exposure, non-heat-exposed conditions, or within-study reference conditions when such comparisons were reported.","outcome":"Physical health, fatigue, stress, prevalence, incidence, or performance outcomes, including dehydration, heat-related illness symptoms, heat stress/strain, kidney function impairment, acute kidney injury, chronic kidney disease, high body temperature, heat-related mortality, and work-performance effects."} | |
| {"review_pmid":"41888952","title":"The effect of hydrogen-rich water interventions on lipid profiles in adults with overweight or obesity and associated metabolic disorders: a systematic review and meta-analysis of randomized controlled trials","abstract":"Objective: Obesity-related dyslipidemia remains a significant health challenge, contributing to increased cardiovascular risk. Hydrogen-rich water (HRW) has been proposed as a potential adjunctive intervention due to its antioxidant and anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate the effects of HRW on lipid profiles in adults with overweight or obesity. Methods: We searched Scopus, PubMed, Web of Science, and Embase for randomized controlled trials (RCTs) published up to November 2025 that compared HRW with placebo or standard water in adults with mean body mass index (BMI) ≥25 kg/m². Random-effects meta-analyses were performed to estimate pooled weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: Twelve articles comprising 13 RCTs (n=757 participants) were included. HRW significantly reduced total cholesterol (TC) (WMD: -6.71 mg/dL; 95% CI: -10.38 to -3.04; P<0.001) and low-density lipoprotein cholesterol (LDL-C) (WMD: -3.21 mg/dL; 95% CI: -6.31 to -0.10; P=0.043). A small reduction in high-density lipoprotein cholesterol (HDL-C) was observed (WMD: -1.16 mg/dL; 95% CI: -1.92 to -0.40; P=0.003). Triglycerides showed no significant change (WMD: -4.21 mg/dL; 95% CI: -17.75 to 9.32; P=0.54). Most trials enrolled overweight or obese adults with cardiometabolic comorbidities. Subgroup analyses were underpowered and considered hypothesis-generating. Conclusion: HRW supplementation in overweight or obese adults produces small, statistically detectable but clinically modest reductions in TC and LDL-C, with minimal effects on TG and HDL-C. These effects are below thresholds considered meaningful for cardiovascular risk reduction and should not justify routine use of HRW as a lipid-lowering therapy outside of research settings, and these findings primarily apply to adults with preexisting metabolic conditions and should not be generalized to all overweight/obese individuals. Any potential role remains limited to an investigational adjunct, and further adequately powered, longer-term RCTs are needed before HRW can be considered in dyslipidemia management.","population":"Adult participants (≥18 years) with a mean baseline body mass index (BMI) ≥25 kg/m² (overweight or obese), including those with associated cardiometabolic comorbidities such as metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), hyperuricemia, impaired fasting glucose (IFG), or type 2 diabetes mellitus (T2DM). Excludes children, normal-weight populations (mean BMI <25 kg/m²), animal studies, and in vitro experiments.","intervention_or_exposure":"Oral consumption of hydrogen-rich water (HRW), operationally defined as drinking water containing dissolved molecular hydrogen (H₂), delivered as pre-packaged HRW or generated in situ via hydrogen-producing tablets or caplets dissolved in water, at any hydrogen concentration (approximately 0.5–7.5 ppm) and daily intake volume (500–2000 mL/day), with estimated daily hydrogen doses ranging from ~3 to >12 mg/day, for any intervention duration (8 to 24 weeks).","comparator":"Placebo water (identical in appearance and taste without dissolved hydrogen content) or standard drinking water without hydrogen supplementation.","outcome":"Primary outcomes: changes in total cholesterol (TC, mg/dL) and low-density lipoprotein cholesterol (LDL-C, mg/dL) from baseline to end of intervention, given their established causal associations with cardiovascular disease risk. Secondary outcomes: changes in high-density lipoprotein cholesterol (HDL-C, mg/dL) and triglycerides (TG, mg/dL). All outcomes measured by standard enzymatic or automated clinical chemistry assays on fasting blood samples."} | |
| {"review_pmid":"41901064","title":"Effects of Nicotinamide Mononucleotide Supplementation on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","abstract":"Background/Objectives: High blood pressure remains a primary modifiable risk factor for cardiovascular disease. Nicotinamide mononucleotide (NMN) has emerged as a promising supplement; however, its efficacy with respect to blood pressure in humans is unclear. This meta-analysis systematically evaluated the effects of various NMN supplements on resting systolic and diastolic blood pressure in adults with elevated blood pressure. Methods: Eligible randomized controlled trials were identified in PubMed/MEDLINE, Scopus, Web of Science, and EBSCO from inception to 13 December 2025. R software combined data from original trials using a common-effects model. Subgroup analyses were performed based on age, BMI, geographical location, intervention duration, NMN dosage, and baseline blood pressure. Results: A total of 349 participants from 10 RCTs with 11 intervention arms were included. Compared with placebo, NMN supplementation was associated with a statistically significant but modest reduction in resting DBP, while the reduction in SBP was not statistically significant. Subgroup analyses showed significant SBP reduction among participants aged 60 years and older. Conclusions: Preliminary evidence suggests NMN supplementation may be associated with a small reduction in resting DBP and a modest beneficial effect on resting SBP in adults aged 60 years and older. Confirmation through long-term, large-scale, high-quality RCTs is needed.","population":"Adults aged 18 years and older who were healthy without cardiovascular, diabetic, or chronic underlying diseases and had elevated blood pressure or early-stage blood pressure elevation; no trials enrolled moderate-to-severe hypertension.","intervention_or_exposure":"Oral nicotinamide mononucleotide (NMN) supplementation in randomized controlled trials, using capsules, tablets, powder, or unreported oral forms, with daily doses ranging from 250 mg to 1500 mg and intervention duration of at least 4 weeks.","comparator":"Placebo control within parallel or crossover randomized trial designs.","outcome":"Resting systolic blood pressure and diastolic blood pressure, based on sufficient pre- and post-intervention data to calculate net blood-pressure changes; subgroup outcomes by age, baseline BMI, region, duration, dose, and baseline blood pressure were also analyzed."} | |
| {"review_pmid":"41938012","title":"Impact of climate change on spontaneous abortion: a systematic review and meta-analysis","abstract":"Purpose: This systematic review and meta-analysis synthesized evidence on the association between climate change-related factors and spontaneous abortion. Patients and method: A systematic literature search across PubMed, Embase, MEDLINE, Web of Science, PsycINFO, and Google Scholar identified English-language observational studies assessing relationships between climate-related exposures and spontaneous abortion. Quality was assessed using the Newcastle-Ottawa Scale, and random-effects models pooled odds ratios. Results: Of 19,167 records, 37 studies met eligibility criteria. Pooled estimates showed significant positive associations between maternal exposure to climate-related factors, including air pollution, high ambient temperature, floods, and wildfire smoke, and spontaneous abortion. Increased risks were observed with sulfur dioxide, ozone, carbon monoxide, nitrogen dioxide, particulate matter, and high ambient temperature/heat exposure. Subgroup analyses showed high temperature was associated with elevated spontaneous-abortion risk among women in lower-middle-income countries and abortions before 20 weeks of gestation. Evidence on floods and wildfire smoke also suggested increased risk. Conclusion: Climate change-related exposures are significantly associated with increased risk of abortion, particularly spontaneous abortion. Findings underscore the need to integrate reproductive health into climate adaptation strategies, strengthen surveillance systems, and develop climate-resilient health infrastructures. Registration: PROSPERO CRD420251120772.","population":"Women of reproductive age, including pregnant women in observational studies reporting induced or spontaneous abortion outcomes, with the primary focus on spontaneous abortion or miscarriage before fetal viability.","intervention_or_exposure":"Climate change-related exposures, including direct and indirect effects such as extreme weather events (floods, heat waves, storms), shifts in temperature or precipitation patterns, high ambient temperature, wildfire smoke, dust storms, and ambient air pollution (SO2, ozone, CO, NO2, particulate matter).","comparator":"Studies with or without comparator groups were eligible; for AutoMeta compatibility, the comparator is lower, absent, or reference climate-related exposure within each original study, such as lower pollutant concentration, lower/reference temperature, or unexposed pregnancy windows.","outcome":"Abortion outcomes, especially spontaneous abortion/miscarriage defined as non-induced pregnancy loss before fetal viability, including study definitions before 20, 25, or 28 weeks of gestation; induced abortion was eligible in the broader review but the primary outcome was spontaneous abortion/miscarriage."} | |
| {"review_pmid":"41939286","title":"Impact of Ambient Air Pollution on Cardiovascular Diseases in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis","abstract":"Air pollution contributes to over 8.1 million deaths annually, predominantly from cardiovascular causes. The burden is significantly higher in low-income and lower middle-income countries, yet most air pollution research is performed in higher-income countries. This review evaluated associations between ambient air pollution and cardiovascular disease in LICs and LMICs. PubMed and Global Health were searched for studies exploring associations between daily increases in gaseous pollutants (SO2, NO2, CO, O3) and particulate matter with cardiovascular mortality and hospital admission in adults. Studies were assessed for risk of bias based on outcome validity, exposure measurement quality, and confounder adjustment. A random-effects model estimated overall and per-pollutant risks from short-term exposure studies, standardized to 10 micrograms/m3 increments. Of 1329 articles screened, 48 met inclusion criteria and 22 included a relative risk suitable for meta-analysis. Short-term PM2.5, PM10, and NO2 exposure were associated with increased combined mortality and hospital admission. This review highlights limited evidence in LICs and LMICs but found positive associations between several ambient air pollutants and cardiovascular hospital admissions and mortality, indicating a need for further research in underrepresented regions.","population":"Adults or all-age populations in low-income and lower middle-income countries as defined by the 2024 World Bank classification, with cardiovascular disease hospital admission or mortality outcomes.","intervention_or_exposure":"Ambient outdoor air pollution exposure, including PM2.5, PM10, SO2, NO2, CO, and O3, assessed as short-term exposure over days to weeks or long-term exposure over months to years.","comparator":"Lower or reference levels of the same ambient air pollutant, with effect estimates standardized where possible to 10 micrograms/m3 concentration increments; indoor and non-ambient occupational air pollution exposures were excluded.","outcome":"Cardiovascular disease outcomes including hospital admission and mortality, overall CVD, myocardial infarction, stroke, heart failure, ischemic heart disease, and related CVD-specific endpoints reported as RR, HR, OR, or other quantitative associations."} | |
| {"review_pmid":"41970007","title":"Effectiveness of Personal-Level Protective Measures Against Air Pollution on Respiratory Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","abstract":"Air pollution, particularly fine particulate matter (PM2.5), poses a significant global health risk, contributing to respiratory, and cardiovascular diseases. While personal-level interventions such as air purifiers and respirators are commonly used to reduce exposure, their effectiveness in improving clinical outcomes remains uncertain. This systematic review and meta-analysis evaluated the efficacy of such measures in reducing adverse respiratory and cardiovascular outcomes. A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to February 2025. Randomized controlled trials (RCTs) assessing the use of air purifiers or respirators in non-occupational settings were included. Meta-analyses were performed using fixed or random-effects models, and effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Twenty-seven RCTs were included. Personal-level interventions significantly reduced indoor PM2.5 (SMD = -2.27; 95% CI: -2.98 to -1.55) and PM10 (SMD = -3.87; 95% CI: -4.59 to -3.16) levels. However, no significant improvements were observed for forced expiratory volume in one second (FEV1) (SMD = 0.04; 95% CI: -0.07 to 0.15), peak expiratory flow (PEF), forced vital capacity (FVC), respiratory symptoms, or blood pressure. Sensitivity analysis showed a significant reduction in FeNO (SMD = -0.16; 95% CI: -0.28 to -0.04). While effective in reducing particulate matter, personal-level interventions showed limited clinical benefits for respiratory or cardiovascular health.","population":"Individuals of any age (children, adults, elderly), sex, or health status (healthy individuals, asthmatics, COPD patients, allergic rhinitis patients) who are exposed to ambient or indoor air pollution in non-occupational settings. Includes non-occupationally exposed workers such as office staff and taxi drivers. Excludes workers with occupational air pollution exposure (e.g., agricultural workers, factory workers) and studies conducted in artificial or industrial environments.","intervention_or_exposure":"Personal-level protective measures used in non-occupational, non-industrial settings, including: (1) air filtration devices such as portable HEPA air purifiers, ionizers, laminar airflow devices, and negative ion generators; and (2) respiratory protection devices such as face masks and respirators. Excludes central ventilation system modifications, stove changes, or source-control interventions.","comparator":"Sham/placebo protective devices (e.g., inactive sham air purifiers, non-filtering placebo masks), no intervention, or standard indoor conditions without active air purification or respiratory protection.","outcome":"Primary outcomes: respiratory health measures including (1) lung function parameters: FEV1, peak expiratory flow (PEF), forced vital capacity (FVC); (2) airway inflammation biomarker: fractional exhaled nitric oxide (FeNO); (3) self-reported respiratory symptoms. Secondary outcomes: cardiovascular outcomes (blood pressure [SBP/DBP], heart rate); indoor pollutant exposure levels (PM1, PM2.5, PM10 concentrations in µg/m³)."} | |
| {"review_pmid":"42003421","title":"The Effect of Cranberry Consumption on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","abstract":"Background: This systematic review and meta-analysis aimed to elucidate the effects of cranberry consumption on systolic and diastolic blood pressure based on relevant randomized controlled trials. Materials and Methods: A systematic literature search was performed across ISI Web of Science, PubMed, Embase, the Cochrane Library, and Google Scholar for trials published until December 2024. Weighted mean differences were calculated using random- or fixed-effects models. Heterogeneity was evaluated using Cochrane's test and I2. The PROSPERO registration number is CRD420251028424. Results: A total of 1204 publications were reviewed, leading to 12 trials for qualitative synthesis and meta-analysis. Pooled effect size indicated statistically nonsignificant reductions of 1.31 mmHg for both systolic and diastolic blood pressure. Stratified analysis showed significant SBP reduction in studies using cranberry juice, duration of 8 weeks or less, participants with mean age <50 years, and predominantly females. Subgroup analysis indicated significant DBP reduction in studies involving both genders, lasting more than 8 weeks, including participants with normal BMI, and mean age below 50 years. Conclusion: Cranberry consumption was not effective in managing SBP and DBP overall.","population":"Adults aged 18 years and older enrolled in randomized controlled trials, including healthy people and participants with metabolic syndrome, type 2 diabetes, NAFLD, coronary artery disease, peripheral endothelial dysfunction and cardiovascular risk factors, elevated fasting glucose/impaired glucose tolerance, or elevated blood pressure; pregnant women, children, animals, and non-randomized studies were excluded.","intervention_or_exposure":"Cranberry consumption as cranberry supplement, cranberry juice, cranberry extract, cranberry powder, cranberry cocktail juice, or Vaccinium macrocarpon products, without combination with other dietary supplements or interventions.","comparator":"Placebo comparator group in randomized controlled trials with parallel or crossover design.","outcome":"Systolic blood pressure and diastolic blood pressure measured at baseline and at the end of the intervention, with sufficient data for meta-analysis."} | |
| {"review_pmid":"42015424","title":"The effect of low-carbohydrate diets on serum concentration of soluble adhesion molecules: a systematic review and meta-analysis of randomized controlled trials","abstract":"Therapeutic potential of low-carbohydrate diets in pathological conditions such as endothelial dysfunction can open new strategies for prevention and treatment of cardiovascular disease. This review pooled the effect of low-carbohydrate diets on circulating intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), E-selectin, and P-selectin in adults. PubMed, EMBASE, Web of Science, and Scopus were searched up to February 2024 for randomized clinical trials. Mean changes in adhesion molecules were compared between intervention and comparison groups using a random-effects model. Nine publications with 333 participants were eligible. Pooled results showed that low-carbohydrate diets significantly reduced E-selectin concentrations compared with control, without heterogeneity. No significant effect was found for ICAM, VCAM, or P-selectin. Low-carbohydrate diets may reduce serum E-selectin, while no significant effects were observed for other adhesion molecules. Given limited studies, dietary heterogeneity, and sensitivity analyses, findings should be interpreted cautiously. Further well-designed trials with clearly defined macronutrient composition are required.","population":"Adults aged 18 years and older regardless of health status, including overweight or obese adults, type 1 diabetes, type 2 diabetes, and overweight participants with atherogenic dyslipidemia in randomized controlled trials.","intervention_or_exposure":"Low-carbohydrate diet defined as less than 45% of calories from carbohydrates, including stricter low-carbohydrate or ketogenic targets such as less than 10% of calories, 10-26%, or 26-45% of total energy intake.","comparator":"Control dietary group in randomized controlled trials; studies without a control group, with LCD mixed with other dietary or pharmacological treatments, or with a low-carbohydrate arm at 45% or more carbohydrate were excluded.","outcome":"Mean changes in serum concentrations of soluble adhesion molecules, including ICAM, VCAM, E-selectin, and P-selectin, with standard deviations or sufficient data to estimate them."} | |
| {"review_pmid":"42032055","title":"Soy isoflavone supplementation and sexual function in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials","abstract":"Postmenopausal women often experience sexual dysfunction, such as vaginal dryness and dyspareunia, due to estrogen decline. While hormone replacement therapy is effective, safety concerns have spurred interest in alternatives like soy isoflavones. This meta-analysis evaluated soy isoflavones' efficacy for sexual function and menopausal symptoms. PubMed, Cochrane, Scopus, and Web of Science were searched through May 2025 per PRISMA guidelines, identifying 13 RCTs (n = 1325) comparing soy isoflavones (40-160 mg/day) with placebo or hormone replacement therapy. Outcomes included Menopause Rating Scale scores. Risk of bias and heterogeneity were assessed. Soy isoflavones significantly improved vaginal dryness and urogenital symptoms, with non-significant trends for vasomotor and psychological symptoms. Effects were dose-dependent and more pronounced in Asian populations. High heterogeneity reflected variability in study designs. Soy isoflavones appear safe and moderately effective for urogenital and sexual symptoms, though further standardized trials are needed to confirm long-term benefits.","population":"Postmenopausal women in randomized controlled trials evaluating sexual function or menopausal symptoms; non-randomized studies, wrong populations, and studies lacking sexual-function outcomes were excluded.","intervention_or_exposure":"Soy isoflavone supplementation, typically 40-160 mg/day, including soy isoflavone tablets, powders, extracts, soy-rich diets, soy drinks, vaginal isoflavone gel, or soy-based products where soy isoflavones were the primary active compound.","comparator":"Placebo, hormone therapy or low-dose hormone replacement therapy, no treatment, or control diet groups.","outcome":"Sexual function and menopausal/urogenital symptoms, including vaginal dryness, dyspareunia, urogenital symptoms, vasomotor symptoms, psychological symptoms, somatic complaints, Menopause Rating Scale, Kupperman Index, vaginal cytology, Vaginal Health Index, and symptom-specific questionnaires."} | |